SAEM: Albuterol Trumps Epinephrine in Babies with Bronchiolitis

Action Points

Explain to patients who ask that bronchiolitis, a wheezing illness of infancy, is the most common cause of hospital admission for children 18 months old or younger.

This study was published as an abstract and presented orally at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed publication.

CHICAGO, May 16 -- Infants with bronchiolitis are 42% more likely to be successfully discharged from the emergency department when they are treated with nebulized albuterol rather than epinephrine.

So reported Paul F. Walsh, M.D., of the Kern Medical Center in Bakersfield, Calif., and colleagues at a meeting of the Society for Academic Emergency Medicine here.

Because meta-analyses have suggested that children treated with epinephrine showed a trend toward reduced hospital admissions compared with those given abuterol, the authors conducted a randomized, double blind study comparing the use of nebulized albuterol with nebulized epinephrine in two emergency departments of teaching hospitals.

They confined their analysis to children from birth to 18 months of age who presented with bronchiolitis that wasn't severe enough to require immediate intubation but did require some treatment.

Criteria for hospital admission were age < 2 months, a respiratory rate > 70/minute on entry or 60/minute following treatment, O2 saturation < 92%, more than mildly increased work of breathing after treatment, dehydration without recovery of feeding, apneic or cyanotic episodes, and either sufficient co-morbidities or a clinical judgment that the child required admission.

Study variables included the effects of the two drugs, severity of illness, and study site on discharge probability. The authors defined severity of illness as mild, moderate, or severe using a previously validated ordinal regression model.

The patients were randomly assigned to receive saline mist, followed by either nebulized racemic epinephrine and two saline nebulizers, or three albuterol nebulizers.

Of the 703 patients included in the final analysis, 352 were assigned to receive albuterol, and 351 were assigned to the epinephrine group.

The authors found that patients who received albuterol were significantly more likely than those who received epinephrine to be successfully discharged from the emergency department, with an odds ratio for albuterol of 1.42 (95% confidence interval 1.03 to 1.98).

The advantage for albuterol was seen among first-time wheezers and among children less than 12 months old.

"The ED treatment of bronchiolitis with nebulized albuterol results in more successful discharges than does treatment with nebulized epinephrine," the investigators wrote.

The study involved investigators at the Kern Medical Center in Bakersfield, and David Geffen School of Medicine at the University of California at Los Angeles; Advocate Christ Medical Center in Oak Lawn, Ill., and Mexico's National Institute of Public Health.

Neither funding sources nor author conflicts of interest were listed.

Reviewed by Zalman S. Agus, MD Emeritus Professor at the University of Pennsylvania School of Medicine

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